03090173 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT �XCONTRACTOR INVORMATION
BUIL DING ADDRESS: MID WAY SIGNS PERMIT N003090173
2c;-4 N PORTAT AUR
R'S NAME: 3290 BASSETT ST PERMIT ISSUE DATE
BRIGHT HORIZON 09/2'1 /2003
(408) 982-9696 SANITARY NO, CONTROL.NO,
ARCH ITECnENGINEER: BUILDING PERMITINFO
BLDG [LER PLUMB MECH
C� � E 0
+Op LICENSEDOat I am CONTRACTOR'S of ludo DECLARATION
fm❑ e ed I affirm Nal 1 am licensed under rovisiuns of Chaper 9(commuming e
ZW with Setion 70(Xpof Divixion3of Ne eusinn JProfcssinm Cotic.and my license is
<< in full If adeff r. O SI ,
>0. icon Lk.
i�,q , Cunt
Y7 AR TEIC S ATION
Ii U 1 understand my plans shall W used as public records
mXP
0 Licensed PndcasimM
3 OWNER-BUILDER DECLARATION
<y I hereby affirm Not I am exempt from the Contractor's License Law for the
0 0 following mannn.(Secfien 7031.5,Business and Professions Cc&:Anycky or county
S$ which¢quire a permit m emslNCt.alter,improve,demolish,Or repair say structure
prior In burbouance,alsurequires the applicant fursuch permit o file aligned suemedt
< Nal he is licensed putsuanuodue provisions nthe Comoc,oriLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
2�0 (commencing with Section IOW)of Division 3 of the Business and Professions Gyle)or
that he u exempt therefrom and the basis for Ne alleged exemption.Any violation of 31631039 . 00
Section 703 LS by any applicant for a Permit ubjects the applicant to a civil penalty of APN NumberOccu ane T
not more than fin hundred dollars($500). - - P y Type
—
❑1,as owner of the pmpeny,or my employees with wages a their sole compensation,
will do the work.and did Wcture is not intended or offered for sale(Sec.70aa,Business
and Professions Cade:The Contractor's License Law dors not apply m an owner of 10 3 - UFER d Inspections
prepeny who builds or improves thereon,and who does such work himself or through his
own employes,provided that such improvements are not mormind or offered for sold.If. 104 — REBAR
however,the building or impmvemen,is sold within one you of completion,the owner.
builder will ham the burden of proving Odd he did not Wild or improve fur purpose of 105 - ANCHOR BOLTS
W.J.
304 - ROUGH ELECTRICAL
❑suer the Project
Ne propory, contesting Code:)licensed contractors to 505 - FINAL ELECTRICAL
ronswcl the pmjeet(Sec.7044,Bnsincst and Professions Cotler)The Contractors Li.
emeLaw does not apply toanowner ofproperty who Wilds or Improves dremon,and 514 - FINAL PUBLIC WORKS
who contracts for such projects with a conuacmr(O licensed putauanl to On Conderemta
License Law.
❑ 1 am exempt under Sec. ,B&P C I.,his recon
ItData
WORKER'S COMPENSATION DECLARATION
1 hereby a(frm under penalty of a jury one of the following declerarions:
ave end will meintsin•Carfare of Consenl to self-insure for Worker'sCompcn-
,as provided for by Section 37M of Ne LSWr Code,for Ne performance of the
for which this prmit is issued.
ave and will maintain Workers Compensation Insured=,as required by Section
of Ne labor Code.for the pertormac of Nework(nrwhicA Nis permit is issued.
orkers Compensation Insureree and Policy mrobera.-v. � Polity FROM
RTIFIC O OF C ION INN FROM W RKERS'
COMPENSATION INSURANCE ,
(Thu Yetion teed not IN,eumpated if the fermi,is fm me hundred dollars(SIM)
He less.)
1 codify Nat in the perfmmance of the work for which this Permit is issued,I shall not
employ any portion in any manncrw as in become subject o the Wortrri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you Mould
become subject to the Worker's Compensation previsions of the Ichor Cron,you must
0 faMwith comply with such provisions m Nis Permit shall W demur revoked.
CONSTRUCTION LENDING AGENCY
,l hereby affirm Nat there is a comoduction)ending agency fm Ne Performance of �—
x
On work for which this permit is issued(Sec.3097,Civ.C.) V .
S1 Q Zanders Name
5 Z Lcndcr's Addreas
I certify Net 1 he"read this application and stale the,On above information is
y t~ Correct.I agree to comply with all city and county on in=n=s and sae laws relating to
�U building construction,and hereby audience representatives of this city to enter upon the
h above-mentioned propertyI.
for emnify adpurpose=
y (We)agree to cove,indemnify end keep handless the City ed Cupertino agaiw
IA inconsequence enW coarsing expenses which may in any way acerve against said City
U7 iI,cPLICAcnccof NcgnmiNDS thisDWiL
�-t PPLICANT N STANDS AND WILL COMPL ALL NON-POINT Issued by: Da[
5 RC NS.
T- .�¢-�3-03 Re-roofs
Signa of ApplicandConuaem� Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle haaallous material
dr1.d by the Cupmi no Municipal Code,Chapter 9.11,and the Health and Safety
e.Sc�ctis dn zss3z(ar. All roofs shall be inspected prior to any roofing material being installed.
Yc
Will the applicant orfuwrc building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7d.
t bandbuds air contaminants as deluded by the Bay Area Air Quality Management all new materials for inspection.
vict?
❑Yns
I have mad the hexa nusmaerlels requirements under Chapter 6.95 or Ne Califon
Health&Safety Cade,Sections 25505,15533 and 8334.1 undcntnrid that if On Wilding
no imcnrly haw• int Nat it u my msponsibilit otiIY the occupant of the
im�`v hi Ipd 4indincer, Carrie. .(OC P.C. Signature of Applicant Date
Owner or not nriectl agent nam All roof coverings to be Class "B" or better